Particular Reports

Below you'll find concise descriptions of the primary reports available. For an in-depth view, simply click on the report images. Please note that while these reports are regularly updated, there might be instances where a description doesn't align with the current version of a report. Rest assured, this page undergoes frequent updates to ensure the most accurate and up-to-date information is provided.

General Dashboard

This report offers a comprehensive snapshot of membership and utilization, aggregating data from a vast array of sources including Eligibility, Medical Claims, Pharmacy Claims, Dental Claims, Hospital Census, Member Registries, and Member Quality. Serving as an ideal starting point, it facilitates deep dives into nearly all available reports, streamlining your data exploration and analytical endeavors.

Eligibility Details Dashboard

This comprehensive report serves as a cornerstone resource for understanding all facets of membership dynamics. Tailored for in-depth analysis and actionable insights, this report allows users to:

Membership Trends: Investigate overarching patterns in membership growth, attrition, or stability to inform strategic planning.
Financials: Dive into the intricacies of member premiums and budget allocations to ensure fiscal responsibility and sustainability.
Classifications: Explore various other member classifications to understand the diverse landscape of your membership base. These classifications include tiers, age, gender, among others.

From this macro-level overview, the report provides the option for users to drill down into detailed reports, offering granular insights into specific metrics related to membership.

Medical Claims Details Dashboard

This comprehensive report serves as an essential tool for users to navigate the multifaceted world of Medical Claims. Designed for depth and utility, this report allows users to:

Leading Indicators: Zero in on top-performing aspects of medical claims to prioritize areas for analysis and action.
Encounter & Annual Evaluation Metrics: Investigate trends in patient encounters and annual evaluations to assess healthcare service delivery and quality.
Account Trends: Explore account-level trends to understand broader patterns in service delivery.
Facility Utilization Analysis: Examine how different facilities are being utilized, enabling a closer look at institutional efficiency and usage patterns.
Specialty Insights: Delve into claims by medical specialty to identify both high-performing and underutilized areas of healthcare.
Emergency Room Metrics: Analyze ER utilization rates by facility and group to pinpoint areas for potential improvement or concern.
Hospital Usage Overview: Assess the extent and nature of hospital utilization to better identify oportunity areas.

From this high-level vantage point, the report provides the capability for users to drill down into specific details, granting unparalleled access to individual claims data for each measured metric.

Pharmacy Claims Details Dashboard

This comprehensive report serves as an invaluable resource for navigating the complex landscape of Pharmacy Claims. Specifically engineered to deliver actionable insights, this report encompasses:

Leading Metrics: Identify the top performers in pharmacy claims to focus your analyses and strategies.
Executive Overview: Gain immediate insights from high-level metrics that summarize key aspects of pharmacy claims.
Prescriber Behavior: Investigate trends among prescribing professionals to recognize patterns that may require further scrutiny.
Therapeutic Class Analysis: Evaluate claims by therapeutic class to identify areas of high activity or potential concern.
Polypharmacy Examination: Probe into instances of multiple medication use to understand their implications and manage potential risks.
Brand vs. Generic Summary: Examine the distribution and performance of brand-name versus generic medications within the claims data.

From this broad perspective, the report allows users to drill down to more granular details, affording a detailed view of individual claims for each metric examined.

Dental Claims Details Dashboard

This all-encompassing report serves as a one-stop resource for a wide array of metrics related to Dental Claims. Crafted to provide both a high-level overview and granular insights, the report allows you to:

Top Metrics: Discover the leading indicators in dental claims for targeted evaluation and analysis.
High Level Summary: Benefit from a high-level synopsis that encapsulates key trends, challenges, and opportunities in dental claims.
Lag Report: Examine time-sensitive data to identify lag patterns, facilitating proactive decision-making.

From this overarching view, the report empowers users to drill down into the specific details, providing unparalleled access to individual claim data for each presented metric.

Hospital Admissions Details Dashboard

This exhaustive report serves as a comprehensive repository for key metrics pertinent to Hospital Admissions, as sourced from Census data. Specifically designed to provide a multi-dimensional view into hospital operations, the report features:

Admission Rankings: Identify top-performing metrics related to hospital admissions for targeted analyses.
Temporal Patterns: Explore monthly and daily trends to gain insights into cyclical variations or other recurring admission patterns.
Admissions Per Day: Quantify the daily admission rates to better understand patient flow and resource allocation needs.
Average Daily Census: Examine trends such as the Average Daily Census to assess the consistent utilization of hospital services over time.
Current Admissions Snapshot: Obtain real-time information on patients who are currently admitted, allowing for up-to-date situational awareness.

From this macro-level overview, the report enables users to delve into finer details, offering a window into specific admissions data for each metric of interest.

Medical Claims Births

This comprehensive report provides a robust analysis of key metrics associated with childbirth. Designed to offer actionable insights, the report allows for an exploration of various dimensions, including:

Temporal Trends: Examine patterns over time, breaking down data by facility, medical provider, and service code to identify potential areas for improvement or further investigation.
Delivery Method Metrics: Evaluate the ratio of vaginal to cesarean births, offering critical insights into practice patterns and health outcomes.

From this high-level overview, the report grants users the ability to drill down into granular details, providing access to specific claims data for each explored metric.

Medical Claims Providers Dashboard

This comprehensive report provides an in-depth Summary of Medical Claims Providers, offering a variety of metrics that facilitate a nuanced comparison of performance and identification of potential areas for improvement. Key features of the report include:

Comparative Analysis: Evaluate providers within the same specialty or billing providers to benchmark performance.
Diagnostic and Procedural Insights: Examine the most frequently occurring diagnoses and procedures attributed to specific providers, specialties, or billing entities.
Utilization Trends: Investigate temporal patterns of service utilization across providers, specialties, or billing providers to identify trends and anomalies.
Member-Level Analysis: Explore the service codes and procedures associated with each high-utilizer member to gain a better understanding of individual patterns.
Procedure & Diagnosis Specificity: Analyze the cohort of members who have undergone a particular procedure or have been diagnosed with a specific condition.

And many more capabilities.

From this high-level overview, the report enables users to drill down into the finer details, offering visibility into specific claims data for each performance metric.

Member Registries Details Dashboard

The Member Registries Detail Dashboard offers a comprehensive view of members enrolled in various plan registries based on specific conditions. Within this dashboard, you can explore:

Breakdown by Register Type
Distribution by Register Name
Count of Members per Condition

From this overview, you have the capability to delve deeper, accessing detailed information about individual members within each registry.

Preauthorizations Details Dashboard

The Preauthorizations Details Dashboard provides a comprehensive analysis of metrics tied to medical preauthorizations. Within this dashboard, you can delve into:

Key Metrics: This encompasses service lines, unique preauthorizations, distinct members, and authorized units.
Trends by Status: Track changes and patterns related to authorization status over time.
Patterns by Category: Explore trends segmented by various categories for nuanced insights.

From this overarching view, users have the capability to drill deeper, accessing detailed data on individual preauthorizations aligned with each metric.

Group Summaries

The Group Summaries Dashboards offer comprehensive overviews tailored to various population groups, such as Super Primary Medical Groups, Primary Medical Groups, and Primary Physicians. Within this meticulously crafted report, you can gain insights into an array of membership and utilization metrics, including:

Membership Metrics: This encompasses member months and associated revenue.
Financial Metrics:
- Medical, Pharmacy, Dental, and Special Payments cost analysis.
- Performance indicators including Total Cost, Surplus/Deficit, and Medical Loss Ratio.
Medical Utilization Insights: Delve into metrics like Total Admissions, Readmissions, ER Visits, encounter rates, and Readmission percentages.
Pharmacy Utilization Breakdown: Review metrics such as Total Prescriptions, Rx PMPM (Average Drugs per Prescribed Member), Generic Prescription Percentage, and PCP Prescription Percentage.
Current Performance Indicators: Stay updated with metrics on Active Members, recent encounters (within the past 3 months), Annual Evaluations, and Potential Chronic Conditions.

From this vantage point, users can further their analysis by drilling down to the Summary Member or exploring intricate utilization details like Medical Claims, Pharmacy Claims, and more.

Summary Member

The Summary Member Dashboard is a comprehensive report at the Member level where the user can see several Membership and Utilization Metrics:

Member Demographic Information: This includes phone numbers, mailing addresses, emails, among others.
Membership Metrics: This encompasses member months and associated revenue.
Financial Metrics:
- Medical, Pharmacy, Dental, and Special Payments cost analysis.
- Performance indicators including Total Cost, Surplus/Deficit, and Medical Loss Ratio.
Medical Utilization Insights: Delve into metrics like Total Admissions, Readmissions, ER Visits, encounter rates, and Readmission percentages.
Pharmacy Utilization Breakdown: Review metrics such as Total Prescriptions, Generic Prescription Percentage, and PCP Prescription Percentage.
Current Performance Indicators: Stay updated with metrics on Active, current Encounters, Annual Evaluations, as well as potential chronic conditions.

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